Cuyahoga Ohio Modelo de carta para la terminación de la atención del médico - Paciente a médico - Sample Letter for Termination of Physician's Care - Patient to Physician

• Category: Cartas - No legales - Terminación
• State: Multi-State
• County: Cuyahoga
• Control #: US-0237LR
• Format: Word

Description

Carta del paciente al médico dando por terminada la atención del médico. Subject: Termination of Physician's Care — Request for Medical Records [Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Address] [City, State, ZIP] Dear Dr. [Physician's Last Name], I hope this letter finds you well. I am writing to formally terminate our physician-patient relationship effective [termination date, typically 30 days from the date of the letter]. After careful consideration and consultation with another healthcare professional, I believe it is in my best interest to seek medical care from a different provider. [Optional: Briefly explain the reason for your decision, such as the need for a specialist, relocation, or preference for a different treatment approach.] I would like to request that you provide me with copies of my complete medical records, including all relevant test results, prescriptions, consultation notes, and any other documents pertaining to my healthcare. You may forward the records to the following address: [Your Name] [Your New Address] [City, State, ZIP] Should there be any charges for the preparation and copying of my medical records, please inform me in advance. To ensure continuity of care, I would also appreciate if you could provide detailed summaries of my medical history, diagnoses, and treatment plans to my new physician: [New Physician's Name] [New Physician's Address] [City, State, ZIP] [Phone Number] Please be aware that I authorize the release of my medical records solely to the new physician mentioned above, and any required consent forms will be provided by them separately. I would like to express my appreciation for the medical care you have provided me over the years. Your dedication, expertise, and professionalism were commendable, and I am grateful for your efforts in guiding me towards better health. If you have any questions or require further information, please do not hesitate to contact me at [your phone number] or [your email address]. Thank you in advance for your attention to this matter. Wishing you continued success and thanking you for your understanding. Sincerely, [Your Name]

Subject: Termination of Physician's Care — Request for Medical Records [Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Address] [City, State, ZIP] Dear Dr. [Physician's Last Name], I hope this letter finds you well. I am writing to formally terminate our physician-patient relationship effective [termination date, typically 30 days from the date of the letter]. After careful consideration and consultation with another healthcare professional, I believe it is in my best interest to seek medical care from a different provider. [Optional: Briefly explain the reason for your decision, such as the need for a specialist, relocation, or preference for a different treatment approach.] I would like to request that you provide me with copies of my complete medical records, including all relevant test results, prescriptions, consultation notes, and any other documents pertaining to my healthcare. You may forward the records to the following address: [Your Name] [Your New Address] [City, State, ZIP] Should there be any charges for the preparation and copying of my medical records, please inform me in advance. To ensure continuity of care, I would also appreciate if you could provide detailed summaries of my medical history, diagnoses, and treatment plans to my new physician: [New Physician's Name] [New Physician's Address] [City, State, ZIP] [Phone Number] Please be aware that I authorize the release of my medical records solely to the new physician mentioned above, and any required consent forms will be provided by them separately. I would like to express my appreciation for the medical care you have provided me over the years. Your dedication, expertise, and professionalism were commendable, and I am grateful for your efforts in guiding me towards better health. If you have any questions or require further information, please do not hesitate to contact me at [your phone number] or [your email address]. Thank you in advance for your attention to this matter. Wishing you continued success and thanking you for your understanding. Sincerely, [Your Name]

Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.